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I was working in a cardiologist’s office when I met Mr. Campbell, a 65-year-old patient who had had a heart transplant three years previously following a viral illness that had damaged his heart irreparably. Mr. Campbell had done very well following his transplant and was a model patient. He never complained about the handfuls of drugs he had to take in order to suppress his immune system to prevent organ rejection. Everyone in the clinic looked forward to Mr. Campbell’s office visits. His joy in his renewed health was infectious. He always had a huge smile and a joke to share with us.
Mr. Campbell came in one November morning 3 weeks earlier than his usual standing appointment. Although he smiled and joked, it was easy to tell that he was not feeling well. He told the doctor and me that he had been feeling weak and tired and had been experiencing a low-grade fever off and on for a couple of weeks. He was presently taking antibiotics for a chest infection. His family doctor had urged him to visit us sooner rather than later, concerned about his infection when Mr. Campbell was taking immunosuppressant drugs.
We took Mr. Campbell into an examining room. His vital signs were normal except for a moderate fever and a slightly elevated heart rate. He had a productive cough and his lungs sounded congested. He looked very pale. The doctor began to examine Mr. Campbell and discovered that he had several enlarged lymph nodes in his neck. Mr. Campbell admitted that his appetite had been “off” and he had lost some weight.
The doctor ordered a battery of tests: blood work, including a complete blood count, a chest X ray and an abdominal CT scan, in addition to his normal cardiac function tests. The results were worrisome. Mr. Campbell was anemic and his platelets were low. His white blood cells were abnormally low. More devastating was a tumor that was discovered during the abdominal CT scan. Mr. Campbell was scheduled immediately for biopsy of his swollen lymph nodes. The results were as we feared: Mr. Campbell was diagnosed with diffuse large B-cell lymphoma.
• What factor put Mr. Campbell at increased risk of developing lymphoma?
• Why is infection common in lymphoma?
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